Frequency, types, and direct related costs of medication errors in an academic nephrology ward in Iran

Figures & data

Table 1. Demographic and clinical characteristics of patients.

Age (mean ± SD)	50.9 ± 17.9 years old
Sex (female/male) [number (percent)]	(129) (31.8%)/277 (68.2%)
Number (percent) of CKD stage 2 patients	88 (21.7%)
Number (percent) of CKD stage 3 patients	111 (27.3%)
Number (percent) of CKD stage 4 patients	38 (9.4%)
Number (percent) of hemodialysis patients	116 (28.6%)
Number (percent) of peritoneal dialysis patients	6 (1.4%)
Number (percent) of patients with functioning kidney transplant	23 (5.7%)
Number (percent) of non-CKD patients	24 (5.9%)
Duration of hospital stays (days) [median (range)]	12.5 (1–66)
Total number of ordered drugs	7762
Number of co-morbidities per patient [median (range)]	4 (1–6)
Number of ordered drugs per patient [median (range)]	18 (4–25)
Number of patients who experienced at least one medication error	350
Total number of medication errors	1373
Number of medication errors per patient [median (range)]	3.5 (1–16)

Table 2. Medication error nodes, types, and frequency, changes in direct medication cost.

Medication error types	Number	Percent
Prescription errors
Inappropriate drug (not most appropriate for indication)	107	7.8%
Inappropriate dosage form (not most appropriate for indication)	24	1.7%
Inappropriate duplication of therapeutic group or active ingredient	54	3.9%
Contraindication for drug	4	0.3%
No clear indication for drug use	251	18.3%
No prescribe drug but clear indication	369	26.9%
Low drug dosage or frequency	237	17.3%
High drug dosage or frequency	175	12.7%
Too short treatment duration	0	0%
Too long treatment duration	58	4.2%
No control of drug interaction	41	3%
Transcription errors	43	3.1%
Administration errors
Drug not administered	1	0.1%
Wrong drug administered	9	0.7%

Table 3. Drug classes involved in medication errors.

Drug classes	Numberof errors	Percent of errors
Cardiovascular drugs	329	24%
Vitamins, electrolytes, minerals	303	22.1%
Antibiotics	254	18.5%
Gastro-intestinal drugs	128	9.3%
Immunosuppressive drugs	62	4.5%
Others (hormonal agents, antigout, analgesics, pulmonary drugs, neurologic and psychiatric drugs, topical agents)	297	21.6%

Table 4. Categorization of medication errors (n = 1373).

Clinical significance	Definition9	Number of errors (%)
No error	Category A:circumstances for events that have the capacity to cause error	12(0.9%)
Error, No harm	Category B: An error occurred but the error did not reach the patient Category C: An error occurred that reached the patient but did not cause patient harm Category D: An error occurred that reached the patient and required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude harm	556(40.5%) 483(35.2%) 26(1.9%)
Error, Harm	Category E: An error occurred that may have contributed to or resulted in temporary harm to the patient and required intervention Category F: An error occurred that may have contributed to or resulted in temporary harm to the patient and required initial or prolonged hospitalization Category G: An error occurred that may have contributed to or resulted in permanent patient harm Category H: An error occurred that required intervention necessary to sustain life	233(16.9%) 63(4.6%) 0 0
Error, Death	An error occurred that may have contributed to or resulted in patient death	0

Notes: Harm: Impairment of the physical, emotional, or psychological function or structure of the body and/or pain resulting therefrom. Monitoring: to observe or record relevant physiological or psychological signs. Intervention: may include change in therapy or active medical/surgical treatment. Intervention necessary to sustain life: includes cardiovascular and respiratory support (e.g. CPR, defibrillation, intubation, etc.) (Based on reference #17).

Yap C, Dunham D, Thampson J, Baker D. Medication dosing errors for patients with renal insufficiency in ambulatory care. Jt Comm J Qual Patient Saf. 2005;31:514–521

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